68063482 - INSPECTOR SPECIALIST

State of Florida•MIAMI, FL

82d

About The Position

The Agency for Health Care Administration is Florida’s chief health policy and planning entity. It administers the Florida Medicaid program, licenses and regulates nearly 50,000 health care facilities, and supports health care transparency initiatives. The Bureau of Medicaid Program Integrity (MPI) works to reduce fraud, abuse, and waste through provider audits and investigations, overpayment recovery, administrative sanctions, and referrals to law enforcement. The Inspector Specialist works in an investigative unit and conducts investigations of Medicaid providers, including provider visits, analysis of billing and other investigative information, identification of overpayments and policy violations, and preparation of investigative summary reports and referral recommendations. The position also prepares and conducts pre-audit work, prepayment reviews, project initiatives, and payment restriction reviews in accordance with approved protocols and state and federal requirements. Duties include research and analysis of complex health and business data, case-status tracking, referrals to law enforcement, collaboration with MPI units and regulatory agencies, and participation in joint data-driven field initiatives. This is a full-time Career Service position with regularly scheduled hours typically Monday through Friday, 8:00 a.m. to 5:00 p.m. The position may involve 1–25% travel and requires on-site visits. It is designated mission essential; work may be required on weekends, holidays, during disasters, or outside normal hours, potentially at another county or staffing location. Background and fingerprint screening are conditions of employment. Interviewees must complete a skills test covering English reading and writing comprehension and understanding of legal proceedings and investigations related to health care fraud and abuse.

Requirements

Two years of investigative, enforcement, health care, or professional experience in a regulatory or oversight setting.
One year of professional experience planning, organizing, and coordinating work assignments.
One year of professional experience using computer software programs such as Word, Excel, PowerPoint, and Outlook.
Knowledge of research or investigative principles, practices, and techniques of research and analysis.
Knowledge of Microsoft Word, Excel, PowerPoint, Outlook, and Internet Explorer.
Knowledge of the Florida Medicaid Program.
Ability to execute projects and assignments accurately and on time in a fast-paced environment.
Ability to collect and analyze data, and plan, design, and conduct research studies.
Ability to work independently, solve problems, and make decisions based on available information.
Ability to understand and apply applicable rules, regulations, policies, and procedures related to research and analysis.
Ability to conduct investigations, coordinate investigative activities, and accurately document investigation results.
Effective verbal and written communication skills and the ability to establish and maintain effective working relationships.
Ability to travel with or without accommodation.
Investigative, research, written and oral communication, and organizational skills.
An associate's degree in a related field such as health law, health science, criminology, criminal justice, or a substantially similar discipline may substitute for experience on a year-for-year basis.

Nice To Haves

Program integrity-related professional certification, such as Certified Fraud Examiner, Accredited Healthcare Fraud Investigator, Certified Financial Crimes Investigator, Certified Insurance Fraud Investigator, or Certified Compliance and Ethics Professional.

Responsibilities

Conduct investigations of Medicaid providers, including visits to providers and analysis of billing information and other investigative findings.
Identify overpayments and violations of Medicaid policies, rules, laws, and statutes.
Prepare investigative summary reports and recommendations for referrals to other entities.
Prepare, lead, and conduct pre-audit preparations, prepayment reviews, and project initiatives under approved unit protocols.
Conduct on-site visits and support consistency with Prevention and Program Oversight (Field Operations) protocols.
Research and analyze complex health and business-related data in investigations involving fraud, abuse, and waste.
Use open-source and proprietary resources to conduct investigations and related administrative actions, and monitor and track case status.
Prepare referrals to law enforcement entities.
Identify, analyze, and interpret trends or patterns in data sets using investigative and research tools.
Collaborate with team members, other MPI operational units, and regulatory agencies, including participation in joint data-driven field initiatives.
Conduct payment restriction reviews in accordance with state and federal requirements.

Benefits

Health insurance, including individual and family coverage, for eligible employees.
A free $25,000 life insurance policy with the option to purchase additional life insurance.
Dental, vision, and supplemental insurance.
State of Florida retirement options, including employer contributions.
Ability to earn up to 104 hours of paid annual leave as a new State employee.
Ability to earn up to 104 hours of sick leave annually.
Nine paid holidays and one personal holiday each year.
Career advancement opportunities.
Tuition waivers accepted by major Florida colleges and universities.
Student loan forgiveness opportunities, subject to eligibility.
Training opportunities.
Flexible Spending Accounts.
Shared Savings Program for select medical services.
Lower prescription drug copays.
Health and wellness discounts.